Prognostic implications of stress test-induced arrhythmias: a systematic review and meta-analysis

The significance of stress-test induced arrhythmias has been examined in prior studies, but there is no clear consensus regarding its significance.

To determine the significance of stress test-induced arrhythmias.

Relevant studies examining arrhythmia in both exercise and pharmacological stress testing were searched for in PubMed, Embase and Cochrane databases from inception to 14 June 2023. The primary outcomes of interest were mortality in ventricular and atrial arrhythmias, and later diagnosis of cardiac disease in atrial arrhythmias.

The presence of any ventricular arrhythmia during stress testing was significantly associated with mortality at all time points: OR 2.11 (95% CI 1.75, 2.54), p<0.00001. This association was still seen in the subgroup of healthy, asymptomatic patients: OR 2.22 (95% CI 1.45, 3.41), p=0.0003. Frequent premature ventricular complexes (PVCs) were associated with higher mortality compared with infrequent PVCs: OR 1.85 (95% CI 1.27, 2.69), p=0.001. The presence of atrial fibrillation (AF) during stress testing was not associated with mortality at all time points: OR 1.53 (95% CI 0.05, 50.19), p=0.81. However, it was associated with later diagnosis of AF: OR 4.60 (95% CI 1.59, 13.26), p=0.005. The presence of atrial arrhythmias during stress testing at all time points was also associated with later diagnosis of coronary artery disease or myocardial infarction: OR 1.82 (95% CI 1.09, 3.03), p=0.02.

Patients experiencing ventricular arrhythmia during stress testing face double the odds of mortality compared with those without such arrhythmias. Atrial arrhythmia during stress testing, on the other hand, shows no association with mortality. However, it is linked to subsequent diagnosis of AF, coronary artery disease and myocardial infarction.